Provider Demographics
NPI:1376055368
Name:RICHARDSON, LAURA (MFN, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MFN, RDN, LDN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFN, RDN, LDN
Mailing Address - Street 1:1858 MICHIGAN AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3332
Mailing Address - Country:US
Mailing Address - Phone:727-410-0010
Mailing Address - Fax:
Practice Address - Street 1:1858 MICHIGAN AVE NE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3332
Practice Address - Country:US
Practice Address - Phone:727-410-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered